Enhanced Prenatal Care (EPC) Program

The EPC program evaluated an intervention intended to improve clinic-based prenatal care for Native American women by adding health promotion and preventive health components. All Native American women presenting for prenatal care through the IHS clinic on the Ft. Berthold Reservation of the Mandan, Hidatsa, and Arikara Nation in North Dakota were eligible to enroll for the enhanced services. Women who presented at the clinic during the enrollment period of April to August 2005 received the following services in addition to care as usual: (a) enhanced screening and assessment to determine high risk behaviors and potential sources of support or barriers to care; (b) group health education services with emphasis on breastfeeding and nutrition information; (c) individualized health coaching for women reporting behavioral risk factors and who requested assistance in making lifestyle/healthy behavior changes; (d) referral to a health psychologist for problems with intimate partner violence, depression, substance abuse, or other sensitive psychological issues; and (e) up to a $250 stipend to assist women in making healthy behavior changes (e.g., walking shoes and exercise videos). Previous enhanced prenatal care programs without health coaching have resulted in positive benefits to women including less postnatal depression, more satisfaction with their prenatal care, and a greater likelihood of breastfeeding compared to women who received only usual treatment (Johnston et al., 2004). We predicted that because our program also provided a health coach and psychological services, women would additionally report more attempts at changing their unhealthy behaviors, including less tobacco and other substance use, better diabetes management compliance, and fewer pregnancy complications. We examined participant’s health behavior changes from pre- to post-enrollment and compared participant’s outcomes with women receiving only usual care and in a state-wide Pregnancy Risk Assessment Monitoring System (PRAMS).

Women participating in the EPC program had greater contact with health care personnel prior to the birth of their child, decreased their use of tobacco during their pregnancy, increased their fruit and vegatable consumption, and were more likely to breastfeed their infant. In addition, their infants had greater birth weights and higher APGAR scores.

If you would like to learn more about the EPC program please contact us at (701) 777-4046 or email vogeltan@medicine.nodak.edu